AB0213 CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS UNDERGOING TOTAL JOINT REPLACEMENT: А 20-YEAR TREND ANALYSIS
Authors: S. Lapshina, I. Akhtiamov, I. Gilmutdinov
Journal: Annals of the Rheumatic Diseases (2022)

Objectives To examine time trends in the characteristics of patients with rheumatoid arthritis (RA) undergoing total joint replacement (TJR). Methods A total of 271 patients (399 joints) with RA underwent TJR of large joints (hip, knee) at Republican Clinical Hospital, Kazan between 2002 and 2021. Of these, 98 patients were retrospectively examined between 2002 and 2011; 183 patients were observed prospectively in the perioperative period by a rheumatologist and orthopedist from 2012 to 2021. Of the 183 patients, 65,5% underwent one joint replacement, 19,1% underwent two joint replacements, 13,7% underwent three joint replacements, and 1,7% underwent four joint replacements during the study period. All patients met the 1987 ACR classification criteria or the ACR/ EULAR diagnostic criteria. Median [interquartile range (IQR)] age at surgery was 56 (49, 63), the time from the onset of RA to TJR was 11 (7, 18) years. During the study period, total knee replacement was performed most often (67.9%). Joint pain (VАS), disease activity - DAS28, functionality of the HAQ index were assessed before the operation, after 6 and 12 months in the active observation group. Results In patients in 2002-2011, TJR were performed earlier from the time of the onset of RA compared to the 2012-2021 group [median (IQR), 10 (7-17) vs. 12 (8-19) years, p = 0.01], and there were more complications of surgery (16.3% vs. 5.4%, p &lt; 0.001). In the later period (2012-2021), there was a decrease in blood loss and operation time, p &lt; 0.05. With respect to RA treatment, a significant increasing trend was observed in the proportion of subjects receiving methotrexate (p 0 , 006 ) and biological drugs and biologics (p &lt; 0.001). In the prospective observation group (n=183), patients were significantly older at the time of TJR with low and moderate activity RA (n=106) compared with high activity (n=77) [median (IQR), 57 (51, 64) vs. 55 (46, 63), p = 0.034]. A significantly less time from RA onset to TJR was observed in patients with high activity, using glucocorticoids. Patients who had the use of glucocorticoids TJR was performed earlier than non-users [median (IQR) 11 (6, 16) and 13 (8, 19) years, respectively, p=0.041] There was no significant difference in time from the onset of RA to TJR, stratified by gender and the use of MTX, biological drugs. At the same time, there was no significant difference in dependence on the activity RA to reduce pain syndrome (VAS), improve function (HAQ) after surgery and presence of postoperative complications. Conclusion Over a 20-year period changes were observed in the characteristics of patients with RA undergoing TJR with an increase in the time before surgery. Perioperative management of patients by a rheumatologist and orthopedist can reduce blood loss, the number of complications after surgery. Patients with high RA activity and using glucocorticoids need TJR at an earlier time. Arthroplasty in patients with highly active RA is also effective in improving functional ability. Disclosure of Interests None declared